Reuters logooDeconstructing “The Lien Machine

MND, September 3, 2015 ~A recent series of Reuter’s articles takes a broad swipe at the industries that helps women find the resources they need to obtain mesh-removal surgeries.

With 100,000 plaintiffs now joined in litigation against seven mesh manufacturers, removal of the polypropylene mesh implant may be the only avenue to find some relief for those disabled by the permanent medical device, used to treat incontinence and prolapse.

As a result of “The Lien Machine,” HERE many women may be scared off from seeking and funding the surgeries they desperately need now, rather than later when their case settles if it ever does.

Knowing what questions to ask is an important tool for women who need surgery. Most mesh injuries do not improve over time, in fact, they often get worse, leaving a woman to suffer.

The following is intended to offer some clarity to this story for those who may seek medical management of their mesh cases to make the road an easier one. (Disclosure- no surgical lending or debt buying firm is a supporter of Mesh News Desk).

Drawing courtesy of Jade R.

Drawing courtesy of JadeR.

 

CASH ADVANCE OR DEBT PURCHASE 

There are two ways to obtain financial help to fund your mesh removal surgery when private insurance does not.   A recent story on MND on Lawsuit Financial LLC, (one-time supporter of this site) provides consumers with guidance on how to borrow conservatively.  These cash advances, used to finance surgery or pay a lapsed mortgage, accrue interest, just like a credit card over time, and therefore can become very expensive.

Dollar sign Scott Steiner, WikiCommons

Dollar sign Scott Steiner, WikiCommons

See What You Need to Know Before You Borrow” HERE.

 

The cash advance company places an uncollateralized lien on her eventual settlement or jury award.  It is expensive money because there is no assurance it will ever be repaid. The percentages accrue over time.

Another vehicle to fund mesh-removal surgery is provided by MedStar, an Austin-Texas-based company that was the focus of the unflattering Reuters reports. In this type of assistance, MedStar, known as a factoring company, buys the discounted medical debt counting on it to eventually be paid by placing a lien on a plaintiff’s settlement or a jury award.

The medical provider determines the debt. There is no interest accruing. It is not unlike the exchanges between banks offering home mortgages. Your bank may sell your mortgage to another lender to collect. It does not change what you owe on your home.  The downside- the cost is often not discounted to the extent it would be for an insurer, Medicare or Medicaid. That is disclosed up front in the fine print.

Bottom Line- Eventually the woman will be expected to pay for her surgery from the settlement money is she is receives or is awarded by a jury. If there is no settlement or award, the bill will be excused by a cash advance company. It may be adjusted or reduced by a factoring company though she is technically on the hook to pay that debt.

 

WHAT SHOULD A PELVIC MESH REMOVAL SURGERY COST?

In the OR, Miklos and Moore

In the OR, Miklos and Moore

The fundamental problems with the Reuters story is it cites insurance reimbursement as indicative of the relative value of a mesh surgery. The insurance industry is slow to catch up with the realities of mesh complications, called by removal surgeon Dr. Veronikis, one of the “darkest chapters in women’s health.”

The Reuters report accuses the surgeon in the story of charging an “inflated bill,” however, without knowing the cost of a surgery, it’s difficult to accuse someone of overcharging.

So what should a pelvic mesh removal surgery cost?

First, it can take anywhere from 20 minutes (partial removal in the office setting usually) to a 4, 5 or 6 hour difficult surgery maneuvering around pudendal nerves, scar tissue, mesh fragments, bladder, urethra, mesh arms, etc.- in other words, a challenge not fit for an amateur.

Dan Christensen, MedStar Funding LLC

Dan Christensen, MedStar Funding LLC

Dan Christensen of MedStar concurs; there is no standard sticker price for a mesh surgery.

“The surgeries come in all shapes and sizes, all done by different doctors in different geographical areas with different levels of experience. It may depend where they practice and their level of expertise. You will see widely differing costs of surgeries also because the surgeon doesn’t know what they are going to encounter.”

In questioning readers what their surgeries cost, Mesh News Desk got the following answers:

One woman from the Midwest said her bill tallied $14,188; another from Canada has been quoted $39,800 by the hospital. That number does not include travel from another country or accommodations.  A woman from Florida says her surgery and three-night hospital stay was $76,894.63.

Those numbers may or may not include the cost of a consult ($1,000) the translabial ultrasound ($1,000), or the urodynamics test (upward of 5,000 to 8,000).

Another woman from New Zealand raised $100,000 to cover the cost of travel to the States to have her mesh removed.

Meanwhile insurance reimburses as little as $350 to $1,600 at UCLA, according to Dr. Shlomo Raz, a leading mesh removal surgeon at UCLA.

Because insurance reimburses so little, many doctors say they are not being adequately compensated for their skill-set or time and do not want anything to do with removal or excision surgeries, not to mention the potential liability.

The doctor in the Reuters story charged $17,000 for a mesh removal surgery, which is in line with the findings of our unscientific survey but again, the reporters used the anemic insurance reimbursement as a standard to declare it an “inflated bill.”

Adding concierge care, that is, book hotels, arranging flights, covering the cost of an OR, thousands more can easily be added to the bill you’re expected to pay.

Bottom Line- Comparing an insurance reimbursement to the actual cost of a surgery is inaccurate and minimizes the severity of these injuries and surgeries needed to correct complications.  Insurance companies and the government receive a discount. In the case of a factoring company, the discount essentially benefits the company purchasing the debt. That’s how they’re paid.

Know what you are buying and what it will cost. Like any purchase- get it in writing. Get the surgical estimate in writing as well. The patient, doctor and lawyer should all have a good idea what the surgery will cost after a medical assessment by an experienced mesh-removal expert. Woman statue resized

 

WHO IS EXPECTED TO PAY THE BILL?

Every time we see a doctor, we are promising to pay the full amount of the charges.  A trip to the emergency room and often the first question is – ‘Who will pay the bill?’  Despite the fact you are bleeding, you often must first sign a paper agreeing to pay the charges.

In the case of a factoring company, the company buys the debt (the medical bill) and becomes the assignee that expects to be paid, whenever. The win-win is the doctor is paid immediately instead of waiting years to receive payment.   The bill is dictated by the medical care she provides and according to MedStar it must be, “usual, customary and reasonable.” In other words, not inflated.

Rick Tadrick, National Director of Business Development for Medfin, another factoring company says in practical terms, if the lawsuit fails, the medical provider and/or the funder is not going to be able to collect anything.

“If it’s diminish value did not reach the threshold we did not estimate it to be, MedFin will sit down with attorney and have to discuss some aspect of a reduction. Everyone participates in the pain of a case that does not meet the threshold we anticipated in recovery.”

Tadrick adds he may not work with that attorney again.

Bottom line– That’s why it is so important a mesh-injured woman has an accurate assessment from a mesh-removal expert, not a doctor who is unfamiliar with mesh complications. The latter may devalue the case.  The former not only makes it easier to obtain funding but eventually it will reflect the actual value of her case when it comes time to settle.

 

IS THE PATIENT TOLD WHAT THAT SURGERY WILL COST?

There should be no surprises.  After a medical workup, the patient and lawyer consult with the doctor to determine an estimated cost of the surgery.

Absolutely, says Christensen of MedStar.

“We inform the patient and the lawyer what the expected charges will be before the procedures are done.  If the patient or her attorney feel the charges are too high, they can elect to shop around to other providers.  To say someone doesn’t know it was going to be that much in the end means she didn’t read the documents.”

As far as the need to obtain surgery, it could be construed as malpractice if a lawyer knows of a way to a client to receive aid and they neglect or refuse to inform the client of that solution.

Christensen says as far as MedStar, there is no “referral fee” or “kickback” for the lawyer who contacts them.

For her part, the only patient quoted in “The Lien Machine,” said she was not adequately informed about the costs. MND asked Traci Rizzo if she received paperwork and estimates in advance of her surgery.

“No comment, lol” she said via email.

Bottom line– If a middleman provides you “concierge services” such as travel, hotel, airfare, expect that will increase your bill as well. Get an estimate in writing. Read the fine print which appears in Rizzo’s contract. “PATIENT further acknowledges that medical providers typically receive more for their services when paid by contractual arrangements, such as this, than if they were paid by health insurance companies, government programs such as Medicare or Medicaid, or  by the patient in cash.”

 

Doctors, WikiCommons, Olga

Doctors, WikiCommons, Olga

 

ARE MIDDLEMEN OPERATING IN THE SHADOWS?

A Mesh News Desk story HERE originally reported in October 2013, may have been the basis for the Reuters story.

The allegations of a “scheme” to profit from transvaginal mesh injuries were made by American Medical System after it was tipped off by one of their consultant/doctors. It refers to middlemen who work in the shadows as brokers. AMS deposed the participants last year though there has since been no follow-up.

Dan Christensen, owner of MedStar, is also an attorney, therefore is required to be an officer of the court. He says AMS alleged the doctor was told to falsify information in a medical report to increase the value of cases. He says that was a misunderstanding.

“I would never be involved with someone who would do something like that.  All anyone saying is whatever you do or don’t do or observe, on these cases you need to document everything!   Treatment notes could be a few lines of chicken scratch and that’s it.  That may suffice in a managed care case being submitted to Blue Cross. When you talk about litigation, it’s important to document everything he sees or does.”

In the case of TVM (transvaginal mesh) litigation, MSO’s (Medical Service Organizations) typically are the middlemen that assist in coordinating care.

Christensen gives an example of how an MSO works.

“Take a surgical facility.  It’s empty Saturday morning. The MSO will say ‘I can fill it where it will otherwise go empty and I will pay you x-dollars whether I use it or not.  The facility will say yes.  Now this MSO says I will buy that block of time at this rate.  Through those relationships, the MSO can negotiate good pricing and guarantee payments to make the medical providers comfortable about doing these surgeries. “

Mesh News Desk has reported on another type of middle man – lead generators who solicit clients to sign up for litigation, whether or not they are injured. How they obtain your name and number is a mystery.  Your editor was even called by one that promised I might be able to recoup dollars by joining in litigation. See the story of “Patrick” HERE.

Bottom Line- Hang up if someone is trying to solicit you over the telephone.  A mesh-injured woman should seek a qualified law firm, preferable one that specializes in cases naming her mesh manufacturer.  See the Southern District of West Virginia, HERE, a federal court in Charleston, where 80,000 mesh cases are consolidated. Click on your manufacturer then on your mesh maker and in the fine print above see which law firms are taking these cases to trial (See Steering committees, Lead and Liaison Counsel).

CAN A WOMAN WALK AWAY WITH NOTHING?

If a woman receives a settlement that doesn’t cover the cost of her medical bills, she can simply refuse it.  Her lawyer will not be happy.  He or she is paid only when the plaintiff agrees to accept the settlement offer and some law firms have spend a million dollars or more to bring one plaintiff to trial. Medicare will get nothing and neither will the doctor.

In that case, MedStar’s Christensen says the companies will put their heads together and come up with a compromised amount and try to get something in her pocket.

Another factoring company that buys medical bills is Arizona-based MedFin.  Rick Tadrick, National Director of Business Development for MedFin says that is why it’s so important a realistic medical assessment of her injuries be done before the surgery is performed.

“Miklos and Moore may say she is not surgical; They will not do one simply to do one.  No doctor will. Any of these others, I don’t believe they will do one to bump up a case either.

If she qualifies for surgery, Tadrick will more likely buy that debt after a review with her attorney to make sure it is a solid case.

Bottom Line – If your case offers a disappointing settlement, most companies will work with you and your attorney to make sure the woman has something. If a jury does not award anything on a case, the debt may be excused completely, even though technically you are still obligated to pay.

HOW THIS ARTICLE MIGHT HURT THE MESH-INJURED PLAINTIFFS

Scales of Justice, WikiCommons

Scales of Justice, WikiCommons

The fundamental problems with “The Lien Machine” is it cites insurance reimbursement as the relative value of a mesh surgery.  In the process it diminishes the seriousness of a mesh-injury and the degree of complication involved in removing an implanted medical device that was intended to be permanent, though never tested on humans before being marketed.

Mesh News Desk has interviewed many doctors who complain that insurance reimbursement rates are an insult to those already hurt by the medical profession and mesh makers. Unless they receive a salary, many opt to do the mesh explants only if insurance is not involved.

Christensen defends MedStar and the way it does business.

“The procedures we have in place I am completely satisfied with in that we do notify what the expected charges are. We have no control over the charges, they are dictated by the medical provider.  Unfortunately they are trying to characterize MedStar is trying to take advantage or gouging these patient but that’s not the truth,” he tells Mesh News Desk.

Reuters takes a swipe at trial attorneys as well. In a follow-up story, it asked the American Tort Reform Association (ATRA) to weigh in on trial lawyers and medical funders. ATRA is behind the tort reform movement and funded by the very big industries, asbestos, tobacco that attorneys take to trial.

Christensen is concerned that the story is being repeated on the internet and held up as an authoritative piece of journalism when in fact, no one from Reuters talked to him or anyone from his company before writing, “The Lien Machine.”

How then as he quoted for the article? Christensen’s comments were taken from his deposition with AMS last year, he says, therefore were out of context.

He has a point.  The Society of Professional Journalists (SPJ) Code of Ethics makes it clear – Give the focus of your story an opportunity to answer all criticisms. It says “Diligently seek subjects of news coverage to allow them to respond to criticism or allegations of wrongdoing.”

See the code HERE.

“Clearly these journalists had an agenda. What could be the net effect is funding entities decide they don’t want anything to do with mass tort clients because of the target they could become if they are trying to help.

“The market needs to be informed, not incited,” he says. #

 

POSTSCRIPT

Defendant manufacturers are now citing the Reuters articles to delay paying hip replacement cases that DePuy (Johnson & Johnson) was ordered to pay in that litigation that covered the medical expenses to have the defective metal-on-metal hips removed. ###

LEARN MORE:

MND, NY Times Transvaginal Mesh Coverage Misses the Big Picture, September 26, 2018